Ethiopia, 16 June 2012: The expansion of rural health services is key to reducing child mortality

Women wait for health services at a village health post in rural Romey Kebele, Ethiopia.

By Sacha Westerbeek

Worldwide, under-5 mortality has declined from more than 12 million deaths in 1990 to 7.6 million in 2010 – yet thousands of children still die every day from preventable diseases. On 14-15 June 2012, the Governments of Ethiopia, India and the United States, together with UNICEF, are convening the Child Survival Call to Action, a meeting to mobilize the world toward one ambitious but simple goal – ending preventable child deaths. This story is part of a series highlighting global efforts to improve child survival.

ROMEY KEBELE, Ethiopia, 16 June 2012 – Eight-week-old Moges Teshome is asleep, wrapped up in a blanket on his parent’s bed, next to the fire where dinner is being prepared. But his sleep is disturbed by coughing and heavy breathing. He has pneumonia.

Moges is the first child of 20-year-old Kobeb Ngussie. “Some days ago my son had a very bad cough and he was breathing very fast. I was afraid,” she said. “My husband told me that I’d better take him to the health post a few minutes from where we live.”

There, Haimanot Hailu, who has been a health extension worker for five years, diagnosed Moges and gave Ms. Ngussie antibiotics to administer to him. Ms. Hailu taught Ms. Ngussie how to wash her hands with soap before giving the medicine to Moges.

Three days into his treatment, Moges was improving.

“He is taking the medicine well, and today I see him getting better,” says Ms. Ngussie said.

Prioritizing child survival

Pneumonia is one of the main causes of under-5 mortality in Ethiopia. About 18 percent of deaths among children under age 5 can be attributed to acute respiratory infections, and 13 percent are caused by diarrhoea. The Ethiopian Health Sector Development Programme IV is prioritizing interventions to tackle these and other major causes of child mortality.

“Young children are exposed to a variety of diseases. Without us knowing it, a lot of children die of pneumonia,” Ms. Hailu said. “We didn’t know what they were dying of, but last July we were trained in detecting and treating pneumonia as part of the ‘integrated community case management of common childhood illnesses’ programme approach.”

The additional training has enabled faster diagnosis and treatment of pneumonia.

“We received a watch to count the breaths of the child. We know now that if the breathing is faster, the child is likely to have pneumonia and we can give treatment,” she continued. “There is no more need for the children to be taken to the health centre or referral hospital.”

Health extension workers save lives

In the past two decades, Ethiopia has witnessed steady and social and economic development, together with the rapid expansion of rural health services. The health extension programme was launched in 2004, and currently over 34,000 government salaried female health extension workers are deployed, working in pairs out of 15,000 village health posts. UNICEF supports the health extension programme, providing supplies including cold chain equipment, delivery beds and medications, and supporting training for health workers.

The free basic health services include community case management of severe acute malnutrition, diarrhoea, malaria and pneumonia. Ethiopia also recently introduced the pneumococcal conjugate vaccine (PCV), which protects against pneumonia, for all children between 6 weeks and 1 year old.

Two days ago, Moges received PCV, as well as his first vaccination against polio.

“It took me at least 20 minutes to convince the mother to have her child vaccinated,” Ms. Hailu said. “She thought her baby was too young and she said there are too many vaccines to be given to him. I told her that her child has the right to be immunized.”

Moges’s parents were also visited by Ms. Hailu before he was born. She explained how to stay healthy during pregnancy, options for safe delivery and how to improve the home environment.

Today, Ms. Hailu visited Moges’s house to administer another vaccine and to perform an impromptu evaluation of the child’s health and home. She recommended Ms. Ngussie build a smokeless stove to protect the family.

“Having smoke in the house is not healthy for the child and it is also bad for you. You can get burned, and you will be exposed to lung disease,” Ms. Hailu explained, describing how to build the stove with readily available materials. She also spoke about hygiene practices like using a latrine and hand-washing.

On track to reducing child mortality

According to Ethiopia’s 2011 Demographic and Health Survey, the under-5 mortality rate has been halved in the past decade, dropping from 166 to 88 deaths per 1,000 live births. The country is on track to meet Millennium Development Goal 4, the goal to reduce child mortality by two thirds by 2015. Scaling-up basic services substantially will help Ethiopia reach this goal.

Still, eliminating all child deaths from preventable causes will require a stronger health system, as well as partnerships, resources and commitment at all levels.